Moderna Is About to Begin Trials for HIV Vaccine
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HIV has resisted efforts to develop a vaccine for 30+ years at this point.
I am already beginning to wonder if the 2020s will be the story of the social transformation caused by mRNA vaccines. An effective and relatively cheap HIV vaccine will be huge.
Apart from Covid and HIV, mRNA is going to have a huge effect on the flu vaccine too. For anyone who doesn't know, predictions are made about what flu strains will dominate the coming winter 4-6+ months ahead of time and the vaccine is made from that. Those predictions may not be accurate, which largely explains the variance of efficacy. mRNA has the potential to reduce that down to 1-2 months so you can potentially react to the actual dominant strains.
Cancer of course isn't a single disease. Even something like lung cancer are a collection of different diseases. But some cancers are caused by viruses. A notable example is cervical cancer where it seems like most cases are caused by HPV strains. Australia is on track to essentially eliminate cervical cancer by 2035 [1]. To be clear, this isn't an mRNA vaccine.
But mRNA vaccines may greatly reduce the time required to develop a vaccine and make it possible to eliminate whole classes of diseases.
This is all super-exciting.
[1]: https://www.vcs.org.au/blog/our-impact/news/australia-can-co....
[1] Messenger RNA expressing PfCSP induces functional, protective immune responses against malaria in mice.
It's nice for a first-world citizen that we were getting vaccinated against a new disease 12-18 months after it was first discovered, but with a big enough supply chain we could potentially be aiming to finish a world-wide vaccination campaign in 6-12 months, before we begin running up against the limits of our current methodologies for clinical trials.
I am no expert but my understanding is that AIDS occurs when a variant targeting receptors more specific to CD4 T-cells begins replicating (or begins replicating at too high a rate), which results in T-cell counts falling below some threshold. So a person will go through an extended period without feeling any symptoms, possibly transmitting the virus to others (hence the importance of widespread, easy access to testing), only to be incapacitated by AIDS later when the "balance" of the variants changes (assuming they do not receive HIV-suppressing medications).
I’m not talking about the scare mongering of long term effects. Just the immediate.
The day after my second moderna shot was worse than any flu I can remember and many of my friends in their 20s and 30s had to take a day off after their shot. I know several people in their 60s who had to take several days to a week in bed from vaccine side effects.
That’s fine for ending a pandemic or curing HIV, but for seasonal flu?
In terms of lost labor days, my anec-data points to this vaccine seeming worse than a seasonal flu.
Also, these vaccines were very rapidly developed so perhaps the next generation of them will be a bit easier on the body.
I know this is just another anecdote, but I get a flu shot every year and have never experienced anything more than a sore arm. With 2nd Moderna dose I had a fever of 103 and was completely out of commission for 36 hours.
It's all relative. The side effects from a flu shot are mild compared to the flu. Ditto for the Moderna vaccine.
I'm sure a second shot of the traditional flu vaccine wouldn't feel great.
Compared to having a sore arm for a couple of days? Or even getting sick for a day or two - at a time I can choose - to just not deal with getting sick later on? Sure. And I'm awfully sure that the flu kills more than the vaccine for it. So many complications for so many people.
And to be fair: The folks you knew in their 60's had an unusual reaction. Older people with their aging immune systems are actually more likely to get little to know side effects to vaccines - younger folks tend to get more. The same goes for folks that are genetically female: You tend to get more side effects (they think this is because so many immune genes are on sex chromosomes, and women have more genes here.).
And to be fair: Taking a day off of work when you are sick isn't such a big deal if you live somewhere with labor protection laws that allow you sick days. It is a little less of a big deal if you live in the US and get paid sick time, but a lot of folks just don't have this so it makes being sick after a vaccine a bigger deal that it should be.
With the second phizer shot, I mild symptoms for a day.
I would say a couple of days of flu is vastly better than some of the other side effects I've seen with other medications. Take for instance:
- Suicidal thoughts - Abnormal heart rhythms - Internal bleeding - Cancer
At the end of the day, we rely on medical professionals to help us with these decisions and weigh the treatment of said ailments against the side effects we may incur if we do or don't take treatment. For what it's worth I've seen the opposite, most folks took the day off just in case there was a side effect, but ultimately everyone was fine. I know I scheduled my vaccine shots for a Thursday so I could have a 3 day weekend assuming I wasn't feeling ill, and I felt fine so I enjoyed my 3 day weekend.
What's funny is the US initially only vaccinated women against HPV because "men can't get cervical cancer". Then it turned out lots of men were getting oral/throat cancers from oral HPV acquired from oral sex. Oops!
> HPV-related throat cancer is on the rise, and the typical patient is a male in his 50s or 60s.
The trail of bread crumbs seems to be there. - HPV - Hep C - Human T-cell leukemia/lymphoma virus (HTLV)
I recall there being a sudden, loud push 10ish years ago, for everyone to get the HPV vaccine.
There were some anti-vax arguments against it for the same reason as there's resistance to sex ed; but no "men can't get cervical cancer" arguments, that I recall.
> Vaccination of secondary target populations e.g. females aged ≥15 years or males, is only recommended if feasible, affordable, cost-effective and does not divert resources from vaccinating primary target population or from effective cervical cancer screening programmes.
like the covid one is sold at super low prices compared to what would normally be possible
but the other products won't have nearly as many customers either
what do you guys think?
Note that mRNA technology is not limited to viruses. The cancer vaccine is actually a misnomer as it is actually a personalized treatment for people who already have cancer [1]:
> The cells from the patient's tumor are analyzed, and genetic sequencing is used to identify twenty neoantigen epitopes that may elicit the strongest immune response in the patient. The sequences encoding the twenty patient-specific epitopes are transcribed and loaded onto a single mRNA molecule. [...] This leads to an induction of both cytotoxic T-lymphocyte (CTL)- and memory T-cell-dependent immune responses that specifically target and destroy the patient's cancer cells that express these neoantigens.
BioNTech has actually started Phase 2 trials for a mRNA-based cancer therapy [2].
[1] https://www.cancer.gov/publications/dictionaries/cancer-drug...
[2] https://www.clinicaltrialsarena.com/news/first-patient-dosed...
In the 90s, sure. Between treatment so effective that you can't pass it on and PreP, the days of HIV is over anyway. Vactination might be a bigger deal in poor countries, but they are also the countries that can least afford it.
If they can cure HIV, that would be another thing.
(also how awesome is the music?)
Of course the above is about odds. Individual exceptions do not prove me wrong.
That doesn't mean HIV isn't horrible. It also doesn't mean congress is right for the right reasons.
And despite President-level dismissal of HIV/AIDS at the time, significant resources were devoted to it in the 80s, such that even though we didn't make huge progress against HIV at the time, the research on HIV progressed the rest of the field.
And a lot of our anti-viral drugs have come out of HIV research as well.
A modern Project Warpspeed probably wouldn't be quite as successful as a Covid19 Warpspeed, because a lot of the first ideas have already been attempted. But with the new sorts of designs that mRNA vaccines allow, there's a lot more that's possible now.
Right now, the problem is more about actually accessing the people who might have HIV, getting them to test themselves regularly, and then giving them access to HIV medication if they are positive. Often these people are on the fringes of society. A vaccine would be an ideal tool to reach these people than asking them to get tested regularly.
HIV is a way harder virus to develop a vaccine for than SARS-CoV-2. For starters, once you have it, HIV is way more dangerous. Most people with covid don't need medical attention at all, they can deal with it themselves. Meanwhile, someone infected with HIV is basically sentenced to death in a couple of years if they aren't medicated (>90% mortality rate). The current covid pandemic is so severe because covid spreads so much better than HIV does. Our immune system can't really deal with HIV in a way that we survive the encounter. With SARS-CoV-2 you only need to slightly nudge the immune system into the right direction. That's a way easier task.
HIV also has an immensely large mutation rate. The genetic diversity in a single individual is larger than the genetic diversity of one entire yearly influenza outbreak. So you need to come up with defenses that help against a gigantic set of HIV viruses. We still need to vaccinate people yearly with an influenza shot, because we can't create universal influenza vaccines yet. It's an open problem similar to how a HIV vaccine is an open problem.
TLDR: There is already something like warp speed for HIV, but we were mostly lucky that it was so easy to come up with a covid vaccine.
also, doesn't your immune system lose like 30% of its T-cells after you seroconvert, but prior to developing AIDS? iirc that's why HIV+ people are considered immunocompromised regardless of viral load.
As for the CD4+ T cells, you are right that their numbers decrease before it's called AIDS. In some individuals the counts can successfully recover to "normal" levels. According to studies, it depends on how early you start treatment.
https://www.aidsmap.com/news/dec-2018/cd4-count-recovery-fre...
Then something like this reminds me that if we as a species were able to unlock the secrets of bio-chemistry (not sure if that's the right term) it would be a game changer unlike any seen so far. And the fact that there is a huge corpus of evidence out there in the world called "life" proving some of the possibilities already gives me hope that while we may never have FTL, the future could still be pretty wild.
FTL drive is not needed; people think too small.
And tell somebody put something together for real, FPL is just a whole lot more sexy.
Garden Earth.
The biggest cultural change for attaining "sustainability" is metaphoric, from extraction to management. Maybe somewhat ironically, proponents should go all Old Testament. Stewards of the Earth and so forth.
Many of our prior cultures had at least some form of this. I don't know when or why we stopped being so. Maybe due to the Enlightenment and then Industrialization.
I vividly remember reading René Descartes as a kid and being shocked by his violent language and metaphors. Stuff like "We must wrest Nature's secrets and make her submit to our will" (paraphrasing, from memory).
Well, using that analogy, I would say, it took us indeed great efforts to reach it, but now we have vast land to colonize - meaning applying all that groundbreaking research into everything. There are so many more technologies avaiable, than just what you can buy on the market.
Sci-Fi is very possible.
edit: oh and about FTL:
I know I do not really understand quantum physics and co. but I think I understand, that no one really understands it yet - so I do not expect FTL in my lifetime, but I would not rule it out.
Max Planck was famously discouraged from studying physics by one of his professors because "in this field, almost everything is already discovered, and all that remains is to fill a few holes." [1]
Having studied physics myself, my opinion is that we may very well be at a similar point right now. The big advancements of the last century in physics (quantum theory, relativity, chaos theory, etc.) brought us an era of swift and sweeping technological progress, and now the easy fruit seems to have been plucked. But there are still plenty of known unknowns, dark matter and dark energy being perhaps the most prominent one. Who knows what unknown unknowns are hiding behind those known unknowns?
For example, we could explain that electricity works because of how electrons move, which would be correct from our point of view, but if we find out that we were living in a simulation, then the explanation would be that this is how "electricity" was coded to behave.
Also, usually in physics a formula is thought to be correct until some new laws/rules are found, then the formula is updated by adding some extra terms and then again thought to be correct.
One human lifespan will be seen as a trivial amount of time to the next step of humanity.
https://www.forbes.com/sites/startswithabang/2016/05/12/the-...
And at some point we also don't have infinite time - we will have heat death of the universe at some point too.
So they can't both be right.
https://www.theguardian.com/news/2015/nov/04/relativity-quan...
We're not anywhere near a technological plateau, we just lost track on funding. Until the fall of the Soviet Union, the US invested a lot of money in foundational research, often not even caring if it would prove useful or possible, and with big enough money behind it that people could plan careers.
These days, researchers have to waste half their working time to chasing the few grants that are still available, and forget about a stable career, job security or enough work-life balance to found a family.
I think it's worth every penny, but at first glance it feels incredibly abstract and disconnected from practical application, as well as expensive. (Though, to be honest, I just looked up the LHC cost and $9Bn USD doesn't feel expensive. I was expected it to come up in the hundreds of billions.)
There's also this famous quote that is frequently mis-attributed to Kelvin: "There is nothing new to be discovered in physics now. All that remains is more and more precise measurement".[0] (I'm not sure who actually said it.)
[0] https://www.quora.com/Which-19th-century-physicist-famously-...
The seeming requirement of FTL to explore the universe is 100% a function of our short life span. If we can't make spacecraft go faster we have to make ourselves last longer.
Oh, the rocket equation really doesn't like option 1.
(Hypothesis: any process we can devise to turn hydrogen into sustenance will be orders of magnitude less efficient than using it as propellant.)
They already recycle water very effectively on the ISS. It's the machine that "turns yesterday's coffee into today's coffee."
Of course if we were that good at biotech we could probably hibernate a good chunk of the flight time too. Might be necessary to wake up periodically to reset the body, but you could probably hibernate most of the duration. Maybe you'd do it with some kind of weird circadian cycle with extremely elongated sleep periods, sleeping like 10X-100X as long as you are awake. During each wake period you check to make sure everything is working properly.
You would not need a Bussard ramjet for the long duration flights I'm thinking of. A nuclear thermal rocket could get you a good deal past solar system escape velocity. Nuclear pulse propulsion could get you up to at least single digit percentages of the speed of light if you didn't mind a little boom-boom. Then you just cruse along on an interstellar transfer orbit until you do a retro-burn to enter the destination star system a few tens of thousands of years later. These are all technologies that are already feasible at least on paper. No new physics is needed.
The future will be pretty wild.
But I still can't even imagine what consciousness is.
Maybe we'll create new intelligences, punt on the consciousness question, and delegate the task to them.
Who cares about humans, as a traveling satellite i will have all the time in the universe, literally
It excites me to think about discovering the origin of our consciousness and being able to transfer that.
I don't think we are capable building computer system (and that includes power system for running it) right now that would last few hundred years without any maintenance, even here on planet.
Or it would at least be very non trivial to build it
Pretty soon, parents will be picking their kid's eye color and temperament. For better or worse. Surely future humans will become a great deal hardier than ourselves.
Maybe we can choose eye color, but temperament? Far too complex, far too many possible side effects.
Just look what happened of the dream that AI could help with Corona
https://www.technologyreview.com/2021/07/30/1030329/machine-...
It is currently trending in the other direction.
Incremental progress may be ideal. Alas, whatever forces that may be, trying to preserve the current equilibrium, fight off change. Until the compulsion to change overwhelms the system.
Lather, rinse, repeat.
So when humanity finally goes carbon negative, it'll be despite the opposition, because they couldn't defend the status quo any longer. Then all that bottled up change will be like a dam bursting.
Hopefully it'll happen sooner than later.
If that's not enough to make a difference, it's because we started too late and the problem is too large, not because technological development is too slow. Admittedly, nuclear could have done the job already, and the issue there is social.
If human lifespan technology moved at half the climate change technology speed, we'd have 25 extra years per decade and be effectively immortal today.
strange to me how nobody questions why beavers only make damns a certain size, birds only make nests and don't go beyond that in complexity.
So many people seem blind to the idea that humans might be near their intellectual limit as a species and assume we will just keep progressing technologically. For all we know it's possible we hit a brick wall in terms of progress. Average human struggles with calculus, what if there was a species that could do advanced math as easily as we do 2 + 2?
Seems the limit for human advancement is tied to rate of learning, life span, and general cognitive ability. If you want more advanced tech you need to focus on those problems
On the flip side, nothing seems more exemplified by humanity than a zeal for doing a thing as big and grandiose as possible: for curiosity, for business, for art, or just for sheer vanity.
I don't think we've seen how far those will take us yet, even w/o improvements to the bottlenecks you suggest. I do agree that those "meta" fields matter and will make a huge difference.
Probably because beavers and birds have made dams and nests the same way for the past 100 years, whereas humans in the same time have developed a bunch of tools and can specialize and distribute the fruits of their expertise without requiring others to be experts themselves.
Perhaps it's not true that on average we know more e.g. math now than we did 100 years ago, because there are so many more people. I believe we are nonetheless much better at teaching and learning now.
It's more than possible that all of this growth will be our downfall, and that that will regulate our growth, however.
Isn't most of this kind of just a matter of fitness, same as why birds become flightless on islands where there are no predators which demand flight to escape from? Basically, building anything more than a minimally-viable nest or a dam requires using energy that could be invested elsewhere to greater evolutionary advantage.
Humans have gone beyond because for as long as we can remember, we've always had vast, vast surpluses of energy, initially through the cooking of meat and agriculture, then via animal labour, and then finally via fossil fuels.
I think we will eventually need a paradigm shift from science being built around human grokable models (e=mc^2) to external human manipulatable models (ie, large scale machine derived models that we can't actually grok but can use for analysis and engineering). I think we're already starting to see this - there are already mathematical proofs that are so large and complex (in the GB range) that they had to be found by automation and only other automation can verify them.
Unlike humans, beavers and most species of birds don't work cooperatively, which means they can't separate the workload needed for survival (e.g. one group hunts, one group builds dams, one group does childcare).
Also, why should I privilege what Chamath has to say on this subject more than any random commentator?
There is so much to learn about the world around us without even hitting physics limits.
And then so much to do with that knowledge.
I am not worried we will run out of problems to solve.
I just think it's wrong to call tiny 'simple' life, just because we are so insanely complex.
Good luck to Moderna.
In theory we already have the technology to eliminate HIV. People taking PrEP have a >99% reduced chance to catch HIV. The drugs used to treat HIV can reduce viral levels in HIV+ people to the point that it's impossible for them to transmit it.
Richard Dawkins has a very good explanation for this in The Blind Watchmaker.
>and is mindlessly progressing along so effectively that despite all of our technological capability we can barely contain it.
There's technological capability and America's punishment fetish because people who get aids "deserve it". If we really wanted to, we would have had one.
but.. it's still not a polyvalent vaccine, it's only targeting one such highly-conserved region, and there's HIV out there that evades BNAbs (5% of HIV+ patients have BNAbs after all, and they eventually progress.. though maybe after changing tropism or something.)
so it may not be all that effective as a strategy, but there's at least some monkey data suggesting it delays or sometimes prevents infection.
More info here: https://www.aidsmap.com/news/mar-2020/hiv-vaccine-generates-...
This may actually reduce the HIV infection rate to a large degree. Or people don't take the effing vaccine despite the benefits. Then yes, probably anybody sexually active should get it.
Agree - if we can get rid of HIV we should. I looked at the exclusion criteria in the trial and it didn't mention use of a prophylactic. Widely available prophylactics have been a huge success with preventing HIV, I wonder how that will impact the trial.
"Anybody taking the vaccine" (not "everybody") will actually not eradicate the virus, but rather protect those who take the vaccine. Much like now with Covid.
Everything else is just a question of the statistical signal detection. Those Studies are planned and designed to provide such a signal, with all we know about HIV prevalence (which is already quite low, in most industrial countries, speaking statistically and for the overall population) and the effectiveness of prophylactic treatment.
Also what I'm hearing the prophylactic treatment is not much fun either... I rather see the danger of participants getting the placebo, drop the prophylactics and think they are protected...
My point being, if we have a magic pill that cures them of a given STD, but there are underlying cultural problems that contribute to elevated STD transmission (such as unprotected sex or rape), etc., then the magic pill is only a bandaid that doesn't address the underlying elevated STD transmission problem.
As a sibling comment stated, maybe the problem is that these Africans believe homeopathic cures like special tea leaves will protect them from HIV when in reality they are just all having unprotected sex, so it's both a cultural and educational issue.
But to the point: the major driver of the early explosion of HIV on the continent was almost certainly large-scale vaccination and medical treatment campaigns by colonial governments, which injected staggering numbers of people in rural areas without adequate disinfection of needles.
In the present, the sociological drivers of HIV spread do include rates of nonconsensual sex (particularly between teen girls and older men). More important factors, however, are historical and contemporary patterns of urban/rural migration and long-distance transit networks. The distinctive forms of cyclical migration created by the shape of the mining industry in apartheid South Africa are the largest reason that the pandemic is so much worse in that region than anywhere else on the continent.
Research is pretty clear that Africans understand that condoms work to prevent HIV transmission - there have now been decades of public education campaigns on the subject. That doesn't mean they are always used, of course, but it's not a knowledge problem.
I admit I am not an expert. I formed an opinion after scanning the official wiki on the topic (https://en.wikipedia.org/wiki/HIV/AIDS_in_Africa) which says things like: "High-risk behavioral patterns are largely responsible for the significantly greater spread of HIV/AIDS in Sub-Saharan Africa than in other parts of the world. Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity." and don't mention anything about migration patterns being the more important factors.
So if this is actually your field of study, it would be helpful if the wikipedia article were updated with the latest research.
That said, I really think you should reflect on how much research you did (read a wikipedia page) before stating that Africa's high HIV rates compared to the rest of the world are due to "a culture of rape/unprotected sex" or quack-medicine. (Also, I don't see "rape" anywhere on the wiki article you linked.)
I never stated those things authoritatively. I threw them out as potential example factors because those were things I saw during my brief wikipedia foray.
> (Also, I don't see "rape" anywhere on the wiki article you linked.)
Yeah because it wasn't on that page but a related page:
Colonial governments were mostly out of Africa after the 1960s.
>In the present, the sociological drivers of HIV spread do include rates of nonconsensual sex (particularly between teen girls and older men). More important factors, however, are historical and contemporary patterns of urban/rural migration and long-distance transit networks. The distinctive forms of cyclical migration created by the shape of the mining industry in apartheid South Africa are the largest reason that the pandemic is so much worse in that region than anywhere else on the continent.
That's being very disingenuous. What makes periodic migration by miners in South Africa different from large-scale worker migrations elsewhere in the world? Mexican farm workers to the US, half of China, or for that matter Canadian, Russian, and Australian miners, or oil-rig workers everywhere. It's not so much the migration patterns, but what the migrants do (or don't do) when "back home".
HIV was probably spreading in the Belgian Congo in the 1920s. It likely spread to the US in the 60s. It takes a decade for HIV to turn into AIDS, which is why we think of the pandemic as starting in the 80s.
The median time is a little longer than that, but the range goes down to less than a year. We think about it as starting in the 1980s because that's when the diverse manifestations were recognized as a common syndrome, not because that's when symptoms first appeared in the US (in fact, there is a case retroactively identified as a death from full-blown AIDS in the US in 1969.)
Do you have a citation for that? I’ve never seen it authoritatively claimed and “almost certainly” seems strong for something which isn’t at the standards for inclusion on the Wikipedia page.
There are parallels between the disinformation in the anti-vax Covid community, and the disinformation in regards HIV in Africa.
https://www.cdc.gov/hiv/basics/prep.html
I think the idea in long term would, should be to replace PrEP.
Probably not. PrEP has some nasty side effects. Those who take it need to get their organ function checked every few months (I think just kidneys?).
Of course this vaccine is just entering trials. We have no idea how effective it is, or what the side effects might be. As such we can only guess and hope that it is better than PrEP - though that is a somewhat low bar.
"HIV-positive individuals who use Truvada to control their infection are more likely to experience kidney damage and bone density loss than those who take it to prevent HIV infection, as so-called pre-exposure prophylaxis (PrEP)[2]. But “no significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years,” according to the U.S. Department of Health and Human Services. Numerous studies have shown that the risk of HIV-negative Truvada users developing kidney disease is not statistically significantly different from those taking placebo[3]."
https://healthfeedback.org/claimreview/hiv-drug-truvada-link...
Please don’t spread this FUD. The side effects are rare and reversible by stopping the medicine. The checks are also required to check for other STIs.
The price for PrEP is also very different from country to country. In some countrys it's almost for free, in some others is very, very expensive.
It won't be necessary for most folks to take both, though, that's just not how things work.
HIV transmission is related to sexual activity not sexual orientation. Being in an open relationship, cheating on your partner, performing unprotected sex, are all examples of behaviors that put people at "higher risk". Being attracted to your own gender does not.
Which all goes back to teh point: HIV transmission isn't related to sexual orientation, even if some sex acts are traditionally attributed to one specific sort of orientation.
I’m bi, and hiv is a big deal in the gay community. I know people who have it, we have clinics around dedicated to treating people with it. Straight people can do anal, straight people can get it otherwise, but this is hitting gay/bi men way harder. It’s okay to acknowledge that
So yes, being a homosexual man is a huge risk factor and probably more significant than being in an open relationship, cheating on your partner or performing unprotected sex unless you live in Sub-Saharan Africa.
If it's 99% effective and has close to zero sideeffects that's very different from 60% effective and significant sideeffects. In both cases there are probably some people you'd recommend it to, but in the first case you may just recommend it to everyone, in the second case probably not.
You could remove it as an endemic disease in the US and Europe. In places like South Africa where a third of the population is infected, nothing less that a blanket vaccination campaign would work.
(And of course it is not easy to find out who the high risk people are when both HIV and sexual promiscuity are stigmatised, so you might need to vaccinate everyone anyway to avoid costly errors...)
So the safety profile will be hugely important in determining how widely to use it.
AIDS is a tough one. It has a shifting antigen. If anyone remembers Stephen King's The Stand, that was the premise for Captain Trips.
If they can inoculate against AIDS, then the human race may just survive the next millennium.
I'm actually thinking more about the vaccination against a shifting-antigen bug.
That's big juju.
Just to be somewhat anal, AIDS is much more common in Southern Africa, where homosexuality is generally either legal or the laws against it weak and unenforced.
It's also much more correlated with race than sexuality. In South Africa, it affects something like 15% of blacks vs 0.3% of whites. Women are also far more likely to have HIV, especially younger ones. I think it's around 30% for pregnant women.
Outside of the West, AIDS is definitely not something that mainly gay men get.
Precision is next to godliness.
As long as there’s no antiviral therapy resistance.
But a vaccine, especially if it is affordable and works for a long time will go even further in ending this pandemic that has gone one for 40+ years.
The assumption is that a vaccine would be long lasting, preventative, and likely cheaper if not cheap. That's not only a significant improvement in quality of life in developed countries, that's truly life changing/giving if available in less developed countries. The COVID vaccines and potentially this are examples of capitalism done right.
The HI virus is very slow (not called "Lentivirus" for nothing) and invests itself in the very stemcells of the cells that would be fighting it. This means it can hide from the immune system, and even the antiviral drugs can only push it back. But by the same token, if it is pushed back into the deepest refuge, it can't really "flood" back into the rest of the body, it has to do so at a a trickle.
If there is a viable vaccine around, even if the virus manages to hide from total extinction in a host at first, it will get squashed whenever it tries to come back into the "light" of the immune system.
At least I hope it will work that way...
So... if HIV has already damaged your immune system, can it take advantage of the vaccine?
Perhaps figuring out that is what the tests are for.
There have even be experimental treatments where HIV infected patients who also got Leukemia got treated with radiation, and then a stemcell donation from someone with such an immunity. And they are indeed cured (for practical purposes, there are some details...). Unfortunately, those donors are rare and the radiation therapy etc is probably worse than the chronic antiviral therapy, which is why this is not a more common treatment for HIV.
Of course, inducing these particular antibodies has been the goal of various immunization efforts. Unfortunately this proved more challenging than it might seem.
It takes the virus years to reach the viral loads necessary to damage the immune system to a noticeable degree. Sure, HIV has some tricks before that point, but patients are generally not immunocompromised until AIDS enters the picture.
Unaffordable pharmaceuticals is a purely American problem and I have no idea why you guys think it's normal or put up with it.
[1] https://www.chemistwarehouse.com.au/buy/100885/tenofovir-dis...
Given the number of gun owners and the number of pharmaceutical companies that let people die in agony to keep the medical insurance industry afloat, it should surely be a serious enough problem to warrant changes in corporate policy.
A major reason why you've entrenched interests is that they have safe seats they can depend on. The US has major issues with acts of gerrymandering that create those safe seats. Most forms of PR are much more resistant to gerrymandering than FPTP is. And if you want people who'll do something regarding healthcare costs, you need to get rid of those safe seats and make them accountable.
It’s cheap in Australia because it’s generic. It’s generic now in the US too, and guess what? It’s $40 per month in the US.
If you take PrEP periodically (2+1+1) that will even last you a lot longer (depending on the frequency of course). I am very glad PrEP exists, and already optimistic about its impact in reducing transmissions. But if we can replace this with a one-shot vaccine, that would be groundbreaking.
To quote Seven of Nine, survival is insufficient. We could survive without a vaccine or a treatment, it would mean tens of thousands of years and billions of people dying from AIDS until our species adapts and HIV becomes just another retrovirus (as some other primate species have with related SIV viruses). We should aim higher than "survival" and end the suffering caused by HIV, and with a vaccine we could do so in this century.
AIDS killed 700,000 in 2020.[1]. That’s worldwide. It’s not even in the top 10.
Diarrheal diseases, entirely preventable with clean water supply, kill three times as many.[2]
Or heart disease which killed ten times as many.
[1] https://www.unaids.org/en/resources/fact-sheet [2] https://www.who.int/news-room/fact-sheets/detail/the-top-10-...
My entire statement was “we don’t need an AIDS vaccine to survive as the human race”.
If AIDS was risking our survival than diarrheal diseases should as well?
The critical distinction is outcomes: until relatively recently, the only outcome of an HIV infection was eventual death from AIDS. This is still the default outcome in most of the world.
Plenty of things kill more people than AIDS, but most of them have substantially less severe individual outcomes: many people survive them, or the social/political solutions are substantially more tenable (healthier eating, access to potable water). And that's even before we consider how AIDS research has advanced the field of medical virology as a whole.
After all, we are only saving a small cities worth of people per year.
What point are you actually trying to make?
On the other hand chemistry is highly temperature sensitive and at some point proteins will just denature. Then again you cannot have rapid growth without water, as plants need evaporation to transport minerals and such from the soil into the plant. And what about phosphorus anyway? Soon most soils may be nothing but dirt. You cannot work around the phosphorus erosion. Once it's lost, it's lost. We better start recycling our feces and the dead now. You kinda need to harden all life, not just humans and crops.
That's not necessarily a given.
Even in EU countries (former HIV researcher, had MD colleagues in a country with budget issues).
Can you elaborate as to how this would improve the prospects of humanity as a whole? If anything, such a development would enable a greater proliferation of other dangerous pathogens.
No, it wouldn't necessarily.
While it's true that a vaccine would apply selection pressure and create a fitness gradient for HIV to evolve against, the virus is still bound by its genetics.
The rate at which we're developing vaccines is increasing dramatically. If our new methods are good enough to quickly adapt, then HIV may have a limited state space left to explore. A single remarkable vaccine could even do this on its own if we're lucky.
The virus can't easily descend down a fitness well to make a jump to a new gradient (ie. dramatic change of receptor bindings).
If you're talking about novel viruses, that's a wholly unrelated issue. There's of course a giant reservoir of zoonotic viruses that may one day make a leap to humans, but if anything, our work to rapidly develop vaccines may give us an increased advantage against new viruses if and when they arise.
Finally, if you're talking "hygiene hypothesis", that under-stimulation of the immune system creates auto immune disorders, has increased interaction with gut flora, or changes the dynamics with which cancer clearance happens, then you may be onto something. But this is a huge unknown where we have a lot of study left to do.
(On a personal note, I left my pursuit of biochem because when I studied it, the prospects looked to be moving at glacial pace and the tools felt akin to using punch cards and truth tables. The problems are massive, dynamical, and it looked too daunting. After the last decade and a half of bio discoveries and innovations, I've changed my outlook completely and am incredibly bullish on biotech. We are going to make incredible strides in the next few decades that will in many ways mirror the rise of tech. I want to find my way back to the field someday.)
Right now, HIV is a manageable condition, but ONLY because of the availability of drugs which suppress the virus. The virus eventually learns how to get around the drugs, at which point the patient either switches drugs or dies in a few years.
Without drugs, HIV is (near) 100% fatal. And since it takes a few years to kill, infected people have plenty of time to pass it on. Which they do.
Also, the first HIV infection feels like a minor cold. Most people would not even know they were HIV positive (until their immune system collapsed), were it not for lab testing.
Then just apply some basic epidemiology to these facts, and you see that you have a disease which has the potential to infect (and thus kill) a sizeable percent of the population. As in double-digit percentages.
The idea behind a vaccine is the give the immune system a sample before it encounters the real virus, which allows it to respond quicker when the real virus arrives, which allows it to prevent the virus to replicate sufficiently to make the person sick.
For someone who already has the virus, the vaccine won't do anything.
Also for some viruses (again see covid-19), it's still advisable to get a vaccine even if you've already been infected. The protection rate and longevity of the vaccines can outweigh infection based antibodies dramatically.
In the case of HIV, it's potentially quite different, because HIV is such a unique disease, that yeah, a vaccine might not help anyway. But otherwise, your comment doesn't apply to vaccines in general (and it didn't seem like you were replying towards any specifics of HIV)
The difference with mRNA vaccines is they let your body build antibodies without it even knowing the virus itself
By what possible mechanism? Does this imply that long COVID is a result of some small amount of lingering virus?
I was under the impression that long COVID was a result of damage caused by the initial infection - not some continuous infection of the actual virus.
Many of the patterns associated with long covid suggest that is a mix of one condition that has a mechanism probably similar to chronic fatigue syndrome and the other is the manifestation of long term sequelae that is common with other respiratory viruses.
My guess is that the vaccine might help with the CFS-like symptoms.
This is different from other disease where the immune system doesn't have enough time to response before the disease kills/damages the body.
If the vaccine can prevent HIV signature evasion, it may very well help control/treat the disease, I think.
What you said applies to most viruses (flu, corona, ...), but not to HIV.
There is a reason we failed to create a HIV vaccine for 30 years, and that reason is that simply presenting the virus just doesn't work.
So this vaccine uses a new quite amazing methodology, instead of presenting the virus, it presents something else designed to trigger the 1 in the million B cell from our bodies which are actually capable of producing a neutralizing antibody. Regular vaccine trigger randomly the other 999999 B cells which produce useless antibodies.
Typically that process takes 10 years for a HIV infected person, after which they produce the proper antibodies.
This approach is called germ-line targeting, and tries to accelerate that 10 year process in 2-3 shots.
"Moderna is seeking 56 individuals, aged 18 to 50 and who are HIV-negative, for the trial, which is estimated to begin on August 19 and conclude in spring 2023"
I would imagine that larger trials would be conducted in places with rampant HIV spread, right? Which shouldn't take an inordinate amount of time.
If the initial stage is already 2 years, I don't see a Phase 3 trial taking less than 3 times that amount of time. It will be super difficult to test. The R0 value of HIV is relatively low.
Might be important to keep an eye out for PrEP access progression and these trails around the world...
Probably a dumb question given that I have little domain knowledge here, but are they really going to get valuable data from 56 individuals? Like, isn't that N really small? How many of them would be expected to contract HIV?
And, I'd imagine that if they are selecting a high-risk population for the trials (e.g., sexually active young gay men), wouldn't a lot of the individuals already be on PREP? Would they have to go off of PREP, and run a potentially much greater risk of contracting HIV if the vaccine doesn't actually work?
> A Phase 1, Randomized, First-in-human, Open-label Study to Evaluate the Safety and Immunogenicity
'Moncef Slaoui, head of Operation Warp Speed until January 2021, was formerly a board member of Moderna and only sold his stake in the company days after his appointment by former President Donald Trump for an estimated $10 million, prompting concerns about the program’s neutrality.'
In the USA, estimated new HIV infections in 2019 35k. Assuming 350 million Americans, that gives a very rough estimate of 1 case out of 10,000 per year.
You can enrich this by shifting target population. You could do this in the USA by targetting high risk communities, or by moving the trial overseas.
An trial in the USA with 10k in each arm could very likely be constructed to generate at least 10 cases per year. Likely up to 50.
https://www.hiv.gov/hiv-basics/overview/data-and-trends/stat...
For a common cold, or other lower-impact disease, you could do a challenge trial.
-Convincing people to take the vaccine would be hard. Look how hard it is with a respiratory pandemic. It's "easy" to be non-high risk for HIV and people probably believe they can't get it, but people seem to continue getting it.
(I'm always surprised at how many people are generally unaware of the rates of HIV in Africa. https://en.wikipedia.org/wiki/HIV/AIDS_in_South_Africa)
AIDs is the disease caused by an HIV infection. COVID-19 is the disease caused by a SARS-COV-2 infection.
If a successful mRNA vaccine is developed to prevent AIDs, it would be extremely important for the vaccinated to know they can still be infected with and spread HIV. It's not any different for SARS-COV-2/COVID-19. The talk in this thread about an mRNA vaccine eradicating HIV is nonsense.
In the past the approch was to only target young girls before they had sex for the first time, which turned out to not reduce the spread of HPV as much as hoped. Only in recent years the recommendation changed to also vaccinate boys and increasingly also people with previous sexual encounters.
"This is also why social conservatives don't like it when scientific progress makes sex safer or better. Sex outside of their ideal scenario (in marriage, at the husband's wish, for reproduction) should be punished, and steps to mitigate that punishment (STD prevention, pregnancy prevention) should be discouraged or lambasted as immoral."
https://www.theguardian.com/commentisfree/2012/oct/16/conser...
https://www.washingtonpost.com/local/dc-politics/why-the-pol...
https://news.ycombinator.com/newsguidelines.html
We detached this subthread from https://news.ycombinator.com/item?id=28211023.
Is this the case in the United States, where the CDC makes recommendations?
And if so, why not administer it only to those children of mothers who test positive?
We don't put everyone on a statin simply because most (i.e. more than half of) people will eventually develop heart disease. Instead, we test and administer statins to only those people who have heart disease risk factors.
We don't give everyone bariatric surgery or weight loss drugs simply because most Americans are overweight or obese. Instead, these remedies are administered only to those who are most likely to benefit.
No drug or vaccine is without side effects. It's clear that there's no such thing as informed consent in today's world. The patient cannot be informed because the side effects are hidden from him. And he definitely hasn't consented if coercion was involved in his decision to receive the treatment.
Because there are known side effects that make them not suitable to some people. Pregnant women should not take them (nor those thinking about getting pregnant). Those of Asian decent need a smaller dose. Those who drink alcohol shouldn't take them. Those who take part in extreme exercise shouldn't take them. They cannot be mixed with some other drugs.
The above is off the top of my head. It probably doesn't apply to them all, there are several different statins to choose from, and many different dosages. A doctor really needs to work through the above (and probably more factors I'm not aware of) to figure out what is best for you.
As a French who was teenager in the 90s, I got vaccinated as almost everyone in my class age, and I am glad that French had it as otherwise I could have catch this fucking virus.